Modifiers Approved List modif appWord文件下载.docx
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onthatclaimline.
ApprovedModifier
NationalModifierDescription
Program-SpecificUseoftheModifierandSpecialConsiderations
8A
CFTR（cysticfibrosis）
Thismodifierisonlyusedforprenatalscreeningofcysticfibrosis.
22*
Increasedproceduralservices
Maybeusedwithcomputedtomography（CT）codeswhenadditionalslicesarerequiredoramoredetailedevaluationisnecessary.
UsedbyLocalEducationalAgency（LEA）todenoteanadditional15-minuteserviceincrementrenderedbeyondtherequiredinitialservicetime.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.
Surgical:
Maybebilledwhenproceduresinvolvesignificantlyincreasedoperativecomplexityand/ortimeinasignificantlyalteredsurgicalfieldresultingfromtheeffectsofpriorsurgery,markedscarring,adhesions,inflammation,ordistortedanatomy,irradiation,infection,verylowweight（forexample,neonatesandsmallinfantslessthan10kg）and/ortrauma（asdocumentedinarecipient’smedicalrecord）.Justificationisrequiredontheclaim.
24*
UnrelatedE&
Mservicebythesamephysicianduringapostoperativeperiod
25*
NCCIassociated
Significant,separatelyidentifiableE&
Mservicebythesamephysicianonthesamedayoftheprocedureorotherservice
26*
Professionalcomponent
27*
47*
Anesthesiabysurgeon
Donotuseasamodifierforanesthesiacodes.
50*
Bilateralprocedure
51*
Multipleprocedures
52*
Reducedservices
Forusewithsurgerycodes
66820–66821,66830,66840,66850,66920,66930,66940and66982–66985.Requires“ByReport”documentation.
UsedbyLEAtodenoteanannualre-assessment.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.LEAdoesnotrequire“ByReport”documentation.
53*
Discontinuedprocedure
Requires“ByReport”documentation.
54*
Surgicalcareonly
Useonlywithsurgerycodes
55*
Postoperativemanagementonly
58*
Stagedorrelatedprocedureorservicebythesamephysicianduringthepostoperativeperiod
Maybeusedwithcodes15002–15431and52601toaddresssubsequentpart（s）ofastagedprocedure.
59*
Distinctproceduralservice
Usedprimarilywithcodes36818–36819and76816.Alsousedwithothercodes,asappropriate,forNCCIpurposes.
62*
Twosurgeons
66*
Surgicalteam
73
Discontinuedoutpatienthospital/ambulatorysurgerycenter（ASC）procedurepriortotheadministrationofanesthesia（tobereportedbyhospitaloutpatientdepartmentorsurgicalclinic,only）
Tobereportedbyhospitaloutpatientdepartmentorsurgicalcliniconly.Requires“ByReport”documentation.
74
Discontinuedoutpatienthospital/ambulatorysurgerycenter（ASC）procedureafteradministrationofanesthesia
76*
Repeatprocedureorservicebysamephysician
77*
Repeatprocedurebyanotherphysician
78*
Unplannedreturntotheoperating/procedureroombythesamephysicianfollowinginitialprocedureforarelatedprocedureduringthepostoperativeperiod
79*
Unrelatedprocedureorservicebythesamephysicianduringthepostoperativeperiod
80*
Assistantsurgeon
90*
Reference（outside）laboratory
Onlyspecifiedprovidersmayusethismodifier.
91*
Repeatclinicaldiagnosticlaboratorytest
99*
Multiplemodifiers
Usedwhentwoormoremodifiersarenecessarytocompletelydelineateaservice;
themultiplemodifiersusedmustbeexplainedintheRemarksfield（Box80）/ReservedforLocalUsefield（Box19）oftheclaim.
AlsousedinspecialcircumstancesasspecifiedbytheDepartmentofHealthCareServices（DHCS）.Foranexample,refertotheSurgeryBillingExamples:
UB-04orSurgeryBillingExamples:
CMS-1500sectionsintheappropriatePart2manual.
AG
Primaryphysician
Usedtodenoteaprimarysurgeon.Inthecaseofmultipleprimarysurgeons,twoormoresurgeonscanusemodifierAGforthesamepatientonthesamedateofserviceiftheproceduresareperformedindependentlyandindifferentspecialtyareas.
Thisdoesnotincludesurgicalteamsorsurgeonsperformingasingleprocedurerequiringdifferentskills.Anexplanationoftheclinicalsituationandoperativereportsbyallsurgeonsinvolvedmustbeincludedwiththeclaim.
UsedbyLEAtodenotelicensedphysicians/psychiatrists.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.
AH
Clinicalpsychologist
UsedbyLEAtodenotelicensedpsychologists,licensededucationalpsychologistsandcredentialedschoolpsychologists.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.
AI
Principalphysicianofrecord
Allowableforallprocedurecodes.
AJ
Clinicalsocialworker
UsedbyLEAtodenotelicensedclinicalsocialworkersandcredentialedschoolsocialworkers.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.
AP
Determinationofrefractivestatewasnotperformedinthecourseofdiagnosticophthalmologicalexamination
Useonlyforophthalmology.
E1
Upperleft,eyelid
UsemodifierSCwithCPT-4code68761（closureoflacrimalpunctum;
bythermocauterization,ligation,orlasersurgery;
byplug,each）toindicateuseoftemporarycollagenpunctalplugs.ModifiersE1thruE4areusedinconnectionwithpermanentsiliconepunctalplugsandproceduresontheeyelids.
E2
Lowerleft,eyelid
Sameasabove
E3
Upperright,eyelid
E4
Lowerright,eyelid
ET
Emergencyservices
F1
Lefthand,seconddigit
F2
Lefthand,thirddigit
F3
Lefthand,fourthdigit
F4
Lefthand,fifthdigit
F5
Righthand,thumb
F6
Righthand,seconddigit
F7
Righthand,thirddigit
F8
Righthand,fourthdigit
F9
Righthand,fifthdigit
FA
Lefthand,thumb
GN
Servicedeliveredunderanoutpatientspeech-languagepathologyplanofcare
UsedbyLEAtodenotelicensedspeech-languagepathologistsandspeech-languagepathologists.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.
GO
Servicedeliveredunderanoutpatientoccupationaltherapyplanofcare
UsedbyLEAtodenoteregisteredoccupationaltherapists.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.
GP
Servicedeliveredunderanoutpatientphysicaltherapyplanofcare
UsedbyLEAtodenotelicensedphysicaltherapists.SeeLocalEducationalAgency（LEA）intheappropriatePart2manualformoreinformation.
GQ
Viaasynchronoustelecommunicationssystem
Usedtodenotestore-and-forwardtelecommunicationssystem.
GT
Viainteractiveaudioandvideotelecommunicationssystems
Usedtodenotereal-timetelecommunicationssystem.
GY
Itemorservicestatutorilyexcluded;
doesnotmeetthedefinitionofanyMedicarebenefitor
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